I was asked about vvus. I decided to research it. If I were a man I would NOT use MUSE
A tale of viagra vs. Muse..
Viagra tale
How one man sought an impotence
cure--and found one
BY AVERY COMAROW
This is a report from Viagra's front lines. It is from
a married man in his early 50s--a friend of this writer
who has tried out Pfizer's new impotence drug. Call
him X; he does not want his name used. And call
him grateful; Viagra worked for him. Is it a wonder
drug? The 75,000 prescriptions written for Viagra in
the first two weeks after it came to market in late
March suggest that many hope it could be--and the
potential market numbers as many as 30 million
American men, a significant share in their 40s or
even younger.
Mechanically, an erection must accomplish two
goals. Blood must flow vigorously into three parts of
the penis stuffed with erectile tissue that absorbs
the blood like a sponge. And the muscles in the
penis and the valves in the veins leading away must
keep the blood from leaking out. When a patient
complains about impotence, a physician first looks
for a history of diabetes or cardiovascular problems,
because the circulation disorders that often
accompany these conditions can interfere with an
erection.
Candor difficulties. X, who has been married
about 30 years, began experiencing erectile
dysfunction--now the preferred medical term for
impotence--about four years ago. He could achieve
an erection but could sustain it less and less often.
Seeking medical advice didn't help. During a
physical exam, the internist posed his usual inquiry
about personal problems. "I said something like,
'Well, I've been having some sexual difficulties,' "
says X. "He looked at me and made a note but
didn't ask anything else, and I just dropped it. I got
the impression that he really didn't want to discuss
it, and I was self-conscious enough as it was." This
conversation echoed an assertion by the National
Institutes of Health, in a 1992 report on impotence,
that "embarrassment of patients and the reluctance
of both patients and health care providers to
discuss sexual matters candidly contribute to
underdiagnosis."
The physician and patient had similar
nonconversations over the next couple of years.
Meanwhile, X's ability to perform slipped from
occasional to rare and, then, inexorably, never. X's
relationship with his wife slowly chilled. "I felt as if
we were work colleagues," says X. "We'd go
places, we'd get done what we had to do around the
house, but there was this huge, dark subject we
wouldn't discuss."
Last February, X mustered the nerve to push his
doctor. That won a referral to a urologist. Once the
specialist learned of X's history of heart disease, he
didn't bother with a physical examination. Nor did
he think X needed specialized tests. "I am 99
percent certain that you've got a circulation
problem," he informed X.
The doctor said X could try mechanical
contrivances like a vacuum cuff or pump. Or he
could have bendable rods surgically implanted. Or,
using a small, fine needle, he could inject
alprostadil, a drug that mimics a natural substance
produced during sexual arousal, into the penis, to
encourage blood flow. X did not care for any of
these options.
Priapism warnings. His reaction was slightly less
negative to the urologist's final proposal: a tiny
alprostadil suppository placed about an inch into
the opening of the penis with the aid of a special
insertion device. Made by Vivus and called the
MUSE system, it produces an erection 60 to 70
percent of the time, and X thought it seemed
somewhat less onerous than the other methods.
Yet many men who try MUSE abandon it because
of insertion discomfort; nearly one third did so in
one large study. The urologist also warned of a
small but real danger of priapism--a painful, ongoing
erection that threatens permanent damage and
must be treated at an emergency room. Too, the
timing discourages spontaneity. The drug works five
to 10 minutes after it is administered, during which
time sitting, standing, or walking around is
recommended to stimulate blood flow. And languid
dallying is out; the effect wears off after 30 to 60
minutes.
"There's a pill coming out in six months, maybe
less," the urologist told X. "Take the MUSE
brochure. Look it over. See what you think. Maybe
the thing to do is to wait for the pill. It's called
Viagra."
The $209 visit did warm up the atmosphere at
home. Armed with the MUSE brochure, X was
inspired to reveal to his wife that he had been
seeking help. "She was touched," he says. "She
thought I had stopped caring at all." While put off by
the fussy MUSE procedure, she was willing to go
along. But X was due for a follow-up talk with his
internist. The couple put off the MUSE decision
until then.
The internist, his interest now piqued, disagreed
with the urologist. X's circulation was fine, he said.
As X lay on the examining table, the internist
pressed X's fingers to the femoral arteries in his
groin. "A strong pulse, right?" The blood vessels to
the penis branch off the femoral arteries, and good
femoral circulation argues against poor blood flow to
the penis.
The internist ordered up a testosterone blood test,
and the results made him smile with satisfaction;
the number was extremely low. A depressed level
of the male sex hormone, pumped out by the testes
under the control of the pituitary gland in the brain,
does not automatically produce erectile
dysfunction--men with low testosterone can have
normal sexual function--but it might explain X's
problem.
X met with an endocrinologist in early April, and left,
for the first time, with hope. The hormone specialist
took a detailed history, including a list of all of the
medications X was taking. He examined X
thoroughly, including a rectal check of the prostate
gland. He was nonjudgmental, empathetic, and
eager to answer X's questions.
Moreover, he was flexible. X's testosterone, he said,
could be boosted either by injecting the hormone
once every week or two or with a testosterone skin
patch. But the shots would require frequent visits,
or X or his wife would have to learn to give them.
X was aware that Viagra had come on the market
the week before. Would it make sense to try the
new drug before turning to supplementary
testosterone? Sure, replied the endocrinologist,
writing a prescription for 10 pills and asking X to
report back. The most excruciating moment of his
four-year ordeal, says X, was when he approached
the pharmacy counter to pick up his prescription.
The clerks at the pharmacy have a habit of
repeating the name of the medication aloud to
prevent mistakes. This time it didn't happen. X was
grateful.
The night X and his wife put Viagra to the test
taught them that the drug is not an aphrodisiac. It
aids an erection but does not cause one. As is true
in the absence of Viagra, stress or nerves play
havoc with sexual response, the couple found. A
more relaxed attitude allowed Viagra to do its work.
The phone call to the endocrinologist would be
effusive.
Viagra facts. U.S. News health writer Mary Brophy
Marcus looked into these common questions about
Viagra:
How does Viagra work?
It enhances the effect of nitric oxide. This chemical
is released into the penis during sexual arousal and
relaxes the organ's smooth muscle tissue so that
blood flows in, producing an erection.
Will Viagra help me?
The success rate is about 70 percent. Problem
candidates usually have conditions like poorly
managed diabetes, blocked arteries, or
long-standing high blood pressure.
Do I have to see a doctor?
Don't trust any doctor willing to prescribe Viagra by
phone who isn't very familiar with your health and
sexual history, and don't get a prescription off the
Internet. Erectile dysfunction can signal illnesses
such as diabetes, heart disease, and certain
prostate conditions. Your regular physician or a
urologist will get a full medical and sexual history,
do a physical exam, and test your blood and urine.
How quickly does Viagra take effect?
It can take as long as an hour, but some men see
results in 20 minutes. Most doctors start their
patients on 50 milligrams of Viagra but may later
alter the dose up to 100 milligrams or down to 25
milligrams. It may take four or five experiences
using Viagra before you learn the dosage and
timing that are best.
How long does the effect last?
Four to six hours, or until orgasm.
How often can I take it?
The approved dosage is no more than one pill a
day. "I know some of my patients, couples who are
high-powered Washington types, who when they
finally get away for a weekend together and want to
have some fun are probably going to take one in the
morning and one at night. That most likely will not
cause a problem," says a Washington urologist. It
might increase the possibility of side effects, which
occur in up to 10 percent of men.
What kinds of side effects?
Mild, temporary reactions such as flushed skin,
headaches, upset stomach, and blue-tinted vision.
(Or a pregnancy.)
Viagra shouldn't be taken along with nitroglycerin
because of blood pressure concerns.
Is Viagra good for women, too?
Jennifer Berman, a urologist at the University of
Maryland Medical Center in Baltimore, believes
there may be as many "impotent women" as
men--women who do not enjoy sex because of poor
lubrication and other physiological factors--and
thinks Viagra could help. This summer Berman will
help conduct a study in Boston. Preliminary results
should be out within a year. Currently, Viagra is not
recommended for women.
Can Viagra improve sex for men who aren't
impotent?
No. As Andrew McCollough, a urologist at New
York University Medical School, says, "If your tank
is full, your tank is full."
reprinted from U.S. News and World Report May 4, 1998
A study of 123 impotent men treated with Vivus' Muse product at the Centre for Impotence and Fertility in Rome, Italy found that Muse failed to make 121 of the penises rigid. In
particular, Asensio & Company reviewed IMS' National Prescription Audit ("NPA") data for new and refill Muse prescriptions for the six (6) months period ended September 30, 1997 and compared
Vivus'.
This from Reuters Money Net:
04/20/98
The financial markets expect a decline in 1998 earnings
for Vivus. Analysts have reduced their forecast 12.2%
during the last month and are now looking for earnings of
$0.65 per share, down from $0.74 per share this time
last month. Considering the new forecast, earnings for
this year are now expected to be down 43.0% from the
$1.14 per share recorded in 1997. |
